Northern Counties Health Care
185 Sherman Drive St. Johnsbury, VT 05819
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $96 | 0% | $96 | Medium |
| Child Dental Cleaning | $79 | 0% | $79 | Medium |
| Sealant placed on the tooth surface to prevent decay | $57 | 0% | $57 | Medium |
| Topical fluoride varnish application | $50 | 0% | $50 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $84 | 0% | $84 | Medium |
| Periodic dental exam - established patient | $47 | 0% | $47 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $80 | 0% | $80 | Medium |
| X-Ray Dental - Complete intraoral series | $176 | 0% | $176 | Medium |
| X-Ray Dental - Four images - bitewings | $65 | 0% | $65 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $32 | 0% | $32 | Medium |
| X-Ray Dental - Two images - bitewings | $48 | 0% | $48 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $112 | 0% | $112 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - One surface, primary or permanent | $164 | 0% | $164 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $218 | 0% | $218 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $272 | 0% | $272 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $165 | 0% | $165 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $218 | 0% | $218 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $179 | 0% | $179 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $144 | 0% | $144 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $170 | 0% | $170 | Medium |